Pain Management

Helping Others Control Discomfort

Approvals

This course is recognized by the California Board of Behavioral Sciences.

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This program is Approved by the the National Association of Social Workers (NASW) (Approval #886463870-6292) for 4 Pain/Symptom Management continuing education contact hours.

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This program is approved for 4 continuing education hours by: The California Board of Registered Nursing # CEP 14462 The National Association of Social Workers (NASW) # 886463870 The Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling #50-14000 Texas Board of Examiners of Marriage and Family Therapists # 628 Texas State Board of Examiners of Professional Counselors #1646 The Texas Board of Social Worker Examiners # 5547

The National Board for Certified Counselors (NBCC) # 6412

Welcome

Welcome to Pain Management: Helping Others Control Discomfort. At SpeedyCeus, we hope that you grow professionally from taking this course. Ultimately our goal is to assist you in rendering the best possible care to your patients, clients and customers.

Using This Course Book

This course is organized into four (4) chapters. Each chapter deals with a different aspect of Pain Management. Study questions appear at the conclusion of each chapter. These questions are designed to help you ponder the nature of pain and its' treatments, and foster a deeper understanding of the topic. It is not counted against you in any way if you do not address the questions, but it will enrich your understanding of Pain Management if you do.

When you have finished studying the coursework, you will be ready to take the online test, prove your knowledge, and be awarded your CEUs.

Learning Objectives

At the conclusion of this course, learners will...

Be able to differentiate between chronic and acute types of pain, and will recognize methods used for assessing and measuring the severity and intensity of pain in adults.

Be able to compare the effectiveness various non-medical methods available to control and alleviate pain as an adjunct to, or in place of, the use of analgesic medications.

Be able to name common medications used to alleviate pain along with their uses, side effects, contraindications and addictive propensities.

Examine the thical aspects of pediatric pain managements and acquire methods for assessing and treating pain experienced by children.

Pain Basics 101

"Pain is inevitable. Suffering is optional."

Anonymous

Pain is a universal experience. Virtually every human who has ever lived has endured both physical and emotional pain, some to a greater degree, and others to a lesser degree, but without fail, every human knows what it means to hurt. In this chapter we will explore the various types of pain that befall human beings, and discuss the concept of pain management.

Even newborn infants are not strangers to pain. There is good evidence to suggest that the fetus in the wonb feels pain. By the 30th week of gestation, it is believed that fetal pain receptors are active and register feelings of discomfort when stimulated in the unborn baby. [i] Shortly after birth silver nitrate eye drops are placed in the baby's eyes to prevent gonorrhea or chlamydia infection from being transmitted from the mother to the baby. These drops cause a stinging sensation that makes the baby's eyes burn. Often blood is drawn from the baby, or an IV is inserted in the infant's vein to medicate or hydrate the child. Baby boys are often circumcised shortly after birth without benefit of anesthesia. Even the bright lights of the delivery room are thought to cause the baby discomfort. Yes, humans get a primer in pain before they even before they ever gulp down their first meal.

What Is "Pain Management"?

Pain management is both an art and a science. The science of pain management deals with finding mehtods and substances to prevent, control, and/or alleviate pain. The art of pain management entails locating and applying the right method or substance to best control the specific kind of pain a person is experiencing. In short, pain management involves treating a person with pain using a singular pain control approach, or a combination of approaches, to make the person as comfortable as possible.

Whether it is a sharp pain, a dull ache, a stinging sensation, a tingling feeling, a throbbing pain, a shooting pain, or a colicky pain, there is a pain management approach to address it. Joint pain, muscle pain, cramps, headache pain, back pain, vascular pain, toothache, tightness, a tear, a fracture, a strain, gas pain, or a sprain, each type fo pain has its own distinct feel, its own special brand of agony. The feeling of physical pain can vary greatly; mild, shartp, severe, or dull. The aim of pain management is to free a person from the torment of pain by providing short-term, intermediate, long-term, or permanent relief. Pain management can be a simple matter, or a very complex one, depending on what is causing the pain, and whether the most effective treatment is applied.

Differentiating Between Acute and Chronic Pain

Acute pain is pain that comes on quickly, can be severe, but lasts a relatively short time. Acute pain may be brought on by something as innocuous as indigestion, or as life threatening as a heart attack. Occasionally one might experience an acute pain shooting through their body for no apparent reason at all, and then it is gone as quickly as it came. Post-operative pain that diminishes within an expected timeframe is thought of as an "acute: pain. Acute pain can last only a moment, or as long as a few weeks, but rarely does it become chronic pain. Chronic pain persists for long periods. It is resistant to most medical treatments and cause severe problems and protracted suffering.

Chronic pain can be caused by many different factors. Often conditions that accompany normal aging may affect bones and joints in ways that cause chronic pain. Other common causes are nerve damage and injuries that fail to heal properly. Undiagnosed infections, organ damage, and variety of diseases can also be the culprits that cause pain that seems to go on forever.

Some types of chronic pain have multiple causes. Back pain, for example, may be caused by a single factor, or any combination of these factors: years of poor posture, improper lifting and carrying of heavy objects, being overweight, ordinary aging of the spine, a genital condition such as curvature of the spine, traumatic injury, wearing high heels, sleeping on a poor mattress, or it can occur without any obvious physical cause at all.

Disease can also be the underlying cause of chronic pain. Rheumatoid arthritis and osteoarthritis are well-known pain vendors, but persistent pain may also be due to such ailments as cancer, multiple sclerosis, stomach ulcers, AIDS, and gallbladder disease.

In many cases, however, the source of chronic pain can be a very complex and even mysterious issue to untangle. Although it may begin with an injury or illness, ongoing pain can develop a psychological dimension after the physical problem has healed. This fact alone makes pinning down a single course of treatment tricky, and it is why health care providers often find they have to try a number of different types of treatments. [ii]

Types of Pain

There are several types of pain, including nociceptive pain (such as pain after surgery and pain due to cancer), neuropathic pain (such as sciatica), and psychogenic pain. [iii]

Nociceptive Pain

Nociceptive (nos-i-sep-tive) pain is caused by an injury to body tissues. The injury may be a cut, bruise, bone fracture, a crush injury, a burn, or anything that damages body tissue. This type fo pain is typically aching, sharp, or throbbing. Most pain is nociceptive pain. Pain receptors for tissue injury (nociceptors) are located mostly in the skin or in the internal organs.

This type of pain is almost universally experienced after surgery. The pain may be constant or intermittent, and often worsens when a person moves, coughs, laughs, or breathes deeply.

Most of the pain due to cancer is nociceptive. When a tumor invades bones and organs, it maycause mild discomfort or severe, unrelenting pain. Some cancer treatments, such as surgery and radiation therapy, can also cause nociceptive pain.

Neuropathic Pain

Neuropathic pain is caused by abnormalities in the nerves, spinal cord, or brain. It may be felt as a burning or tingling sensation or as hypersensitivity to touch or cold. Neuropathic pain includes such syndromes as phantom limb pain, postherpetic neuralgia (shingles), reflex sympathetic dystrophy (injury to non-nerve tissue), and causalgia (injury to nerve tissue).

Phantom limb pain is seemingly felt in an amputated part of they body, usually a limb. It differs from phantom limb sensation, the feeling that the amputated part is still there, which is much more common. Phantom limb pain cannot be caused by a problem in the limb; rather, it must be caused by a change in the nervous system above the site where the limb was amputated. The brain misinterprets the nerve signals as coming from the amputated limb. Usually, the pain is felt in the toes, ankle, and foot of an amputated leg or the fingers and hand of an amputated arm. The pain my resemble squeezing, burning, or crushing sensations, but it often differs from any sensation previously experienced. For soem people, phantom limb pain occurs less frequently as time passes, but for others, it perisists.

Postherpetic neuralgia results from herpes zosters (shingles), which causes inflammation fo nerve tissue. The pain is felt as a constant deep aching or burning, as a sharp and intermittent pain, or as hypersensitivity to touch or cold. The pain may be debilitating.

Reflex sympathetic dystrophy (complex regional pain syndrome, type 1) and causalgia (complex regional pain syndrome, type 2) are chronic pain syndromes. They are defined as persistent burning pain accompanied by certain abnormalities that occur in the same area as the pain. Abnormalities include increased or decreased sweating, swelling, changes in skin color, and damage to the skin, hair, nails, muscle, and bone (including muscle wasting and bone loss). Both syndromes typically occur after an injury. Reflex sympathetic dystrophy results from injury to tissues other than nerve tissue. Causalgia results from injury to nerve tissue. Causalgia results from injury to nerve tissue.

Some types of reflex sympatheetic dystrophy and causalgia are made worse by activity of the sympathetic nervous system, which normally prepares the body for stressful or emergency situations--for fight or flight.

Pain Assessment and Documentation

No laboratory test can document the presence or the severity of pain. Doctors begin to assess pain by asking about the history and characteristics of pain, so that they can identify its cause and develop a treatment strategy.

Numeric Rating Scale

To assess the severity of pain, medical professionals often use a numeric rating scale of 0 (none) to 10 (severe, or the worst pain imaginable) or ask the person to describe the pain as mild, moderate, severe, or excruciating. Some patients are unable to do this with only verbal instructions, but may be able to look at a number scale and point to the number that describes the intensity of their pain.

Color Scale

This scale is a colored stripe in which color gradually changes from white (no pain) through shades of pink to dark red (worst possible pain). The patient is asked to point to the area on the scale that shows their level of pain. To obtain a number for documentation, they physician or nurse uses the scale parallel to the color stripe to find the number corresponding to the area where the patient points.

Several other pain scales are available to assess the pain of a child or infant, but those will be presented in the last chapter of this course which is dedicated to the discussion of pediatric pain.

Documentation of Pain

It is important to track and record how responsive a patient's pain is to various types of treatments and triggers. A patient may report reduced severity of pain a hsort while after receiving a pain medication or an abrupt increase in pain after a session of mild exercise. A 24-hour flow sheet that includes hourly notations as to the patient's pain scale score, along with comments as to what the patient was doing, and treatments received during the hour previous to the notation can help the doctor deterrmine both the cause of the pain, and when and how to treat it.

Progress notes can also be used to summarize the type and severity of the pain that a patient is experiencing. These notes should indicate the intensity and characteristics of the patient's pain, along with current treatment and future pain plan.

Methods Used for Treating Pain

In the next two chapters we will discuss the various methods used to treat pain. These methods will include drug therapies, physical therapy, therapeutic exercise, Cognitive-Behavioral mehtods and physical methods. Due to a plethora of pain management studies over the past decade, a myriad of new options for pain management have recently been developed based on a better understanding of why people hurt, and how to help them restore comfort to their lives.

Study Questions

Answering the following questions is an optional activity. These questions are provided as a study aid to help you prepare to take the post test.

1. Please define what is meant by "pain management."

2. At what point does acute pain become chronic pain?

3. Take into consideration that there are three types of pain. How does this factor complicate the process of pain management?

4. How does the color scale simplify the process of determining the severity of a patient's pain?

5. Why would it be necessary to note the patient's activities and treatments on a 24-hour flow chart? __________________________________________________________________________________

Question.No.1.Which of the following statements do NOT apply to pain management?

a.Pain management is both an art and a science b.Effective pain management always results in complete alleviation of a patient's pain c.Pain management can involve a singular approach, or a combination of approaches d.All types of pain can be addressed with pain management techniques

Question.No.2.Which of the statements does NOT describe acute pain?

a.Comes on quickly b.Can be severe c.Is not an indicator of a serious medical conditiond.Diminishes within an expected time period

Question.No.3.Chronic pain can be described as:

a.Pain that persists for long periods of time b.Is resistant to most medical treatment c.May have multiple causes d.All of the above

a.All problems are solved regarding pain b.There may be a lingering psychological dimension that needs to be addressed.c.Any further complaints of pain are clear symptoms of malingering. d.The patient should stay on pain medication as long as possible to make sure there is no pain.

Question.No.17.Nociceptive Pain is caused by:

a.Abnormalities in the nerves b.Abnormalities in the spinal cord c.Abnormalities in the brain d.An injury to body tissues (such as a cut, bruise, burn,etc)

Question.No.18.Neuropathic pain is caused by:

a.Abnormalities in the nerves, spinal cord or brainb.An injury to body tissues c.Eating too many sweets d.Having to take too many CEU courses